The subject matter disclosed herein generally relates to an applier for surgical clips. More particularly, the subject matter disclosed herein relates to a ligating clip applier capable of sequentially delivering a number of clips stored in a clip channel.
Laparoscopic, endoscopic, and other minimally invasive surgical techniques enable surgeons to perform fairly complicated procedures through relatively small entry points in the body. The term xe2x80x9claparoscopicxe2x80x9d refers to surgical procedures performed on the interior of the abdomen, while the term xe2x80x9cendoscopicxe2x80x9d refers more generally to procedures performed in any portion of the body. Endoscopic surgery involves the use of an endoscope, which is an instrument permitting the visual inspection and magnification of a body cavity. The endoscope is inserted into a body cavity through a cannula extending through a hole in the soft tissue protecting the body cavity. The hole is made with a trocar, which includes a cutting instrument slidably and removably disposed within a trocar cannula. After forming the hole, the cutting instrument can be withdrawn from the trocar cannula. A surgeon can then perform diagnostic and/or therapeutic procedures at the surgical site with the aid of specialized medical instruments adapted to fit through the trocar cannula and additional trocar cannulas providing openings into the desired body cavity.
Some known advantages of minimally invasive surgical techniques include reduced trauma to the patient, reduced likelihood of infection at the surgical site, and lower overall medical costs. Accordingly, minimally invasive surgical techniques are being applied to an increasingly wider array of medical procedures.
Many surgical procedures require body vessels to be ligated during the surgical process. For example, many surgical procedures require cutting blood vessels (e.g., veins or arteries), and these blood vessels may require ligation to reduce bleeding. In some instances a surgeon may wish to ligate the vessel temporarily to reduce blood flow to the surgical site during the surgical procedure. In other instances a surgeon may wish to permanently ligate a vessel.
Vessel ligation may be performed by closing the vessel with a ligating clip, or by suturing the vessel with surgical thread. Performing vessel ligation using surgical thread requires complex manipulations of the needle and suture material to form the knots required to secure the vessel. Such complex manipulations are time-consuming and difficult to perform, particularly in endoscopic surgical procedures, which are characterized by limited space and visibility. By contrast, ligating clips are relatively easy and quick to apply. Accordingly, the use of ligating clips in endoscopic surgical procedures has grown dramatically.
Ligating clips may be classified according to their geometric configuration as either symmetric clips or asymmetric clips, and according to the material from which they are manufactured. Symmetric clips are generally xe2x80x9cUxe2x80x9d or xe2x80x9cVxe2x80x9d shaped metallic clips that are substantially symmetrical about a central, longitudinal axis extending between the legs of the clip. By contrast, asymmetric clips lack an axis of symmetry. For example, U.S. Pat. No. 4,834,096 to Oh et al. describes a polymeric, asymmetric surgical clip in which a first leg member includes a lip that mates with the second leg member to lock the clip in place. Asymmetric clips have certain advantages over symmetric clips. For example, because asymmetric clips are formed from polymeric materials, the mouths of asymmetric clips can be opened wider than the mouths of symmetric clips. This allows a surgeon to position the clip about the desired vessel with greater accuracy. In addition, a clip of the type described in U.S. Pat. No. 4,834,096 can be repositioned before locking or latching the clip on the vessel, a process referred to as xe2x80x9capproximatingxe2x80x9d the clip, or to be removed from the vessel.
Ligating clips are applied using mechanical devices commonly referred to as surgical clip appliers, ligating clip appliers, or hemostatic clip appliers. Surgical clip appliers adapted for endoscopic surgical techniques include a shaft adapted to be inserted through an endoscopic cannula to access a surgical site in a body cavity and a jaw assembly disposed at the distal end of the shaft for retaining a surgical clip. In use, the clip is positioned over the desired vessel and the jaw is actuated, typically using a mechanism disposed in the handle of the device, to close the clip about the vessel.
Multiple clip applier systems have been developed that enable surgeons to deliver multiple symmetric surgical clips to an endoscopic surgical site. In general, these systems provide a surgical clip channel within the shaft of the device and a mechanism for delivering the surgical clips through the shaft to the jaw assembly. For example, U.S. Pat. Nos. 5,100,420 and 5,645,551 to Green et al. describe a device for delivering and applying multiple surgical clips to an endoscopic surgical site. Similarly, U.S. Pat. No. Re 35,525 to Stefanchik et al. aims to provide an endoscopic multiple ligating clip applier with a venting system. U.S. Pat. No. 5,700,271 to Whitfield et al., European Published Patent Application No. 0 409 569 A 1, and European Patent No. 0 596 429 B1 propose other clip applier designs.
As endoscopic techniques have been developed, certain inadequacies in the available surgical equipment have become apparent. For example, the jaws of the applier, which are typically used to close a clip around a vessel, may exert unequal pressure on the clip, resulting in a xe2x80x9cscissoringxe2x80x9d effect and damage to the vessel. In other instances, the clip may not be properly oriented when it is placed within the jaws or may slip out of alignment during application. This may result in the loss or misapplication of the clip. In still other instances, the applier may jam or may simply fail to deploy a clip.
Further, existing multiple clip applier systems have been designed for symmetric clips and are not well suited to satisfy design issues unique to asymmetric clips. For example, symmetric clips can be retained in clip jaws by holding opposing surfaces of the clip""s legs in opposing channels. By contrast, asymmetric clips cannot easily be retained in opposing channels because the clip""s legs deform when the clip is closed. In addition, when symmetric clips are closed on a vessel, the opposing legs of the clip apply substantially even pressure to the opposing sides of the vessel. By contrast, the opposing legs of an asymmetric clip may apply varying pressure to opposing sides of a vessel when the asymmetric clip is closed. Further, locking or latching asymmetric clips of the type described in U.S. Pat. No. 4,834,096 function best when force is applied at or near the distal ends of the clip legs. Still further, asymmetric clips of the type described in U.S. Pat. No. 4,834,096 may need to be placed under compression to be retained in the clip channel. Thus, conventional clip advancing mechanisms designed for symmetric clips may not reliably advance asymmetric clips. In addition, conventional clip advancing mechanisms designed for symmetric clips may not provide the ability to approximate a clip.
In sum, conventional clip appliers designed for symmetric, metal clips suffer from certain deficiencies and are not adapted to deliver asymmetric, polymer based latching clips. Accordingly, there is a need to provide an endoscopic clip applier that can reliably deliver a sequence of clips and in a manner which minimizes the risk of damage to the vessel. Further there is a need for an endoscopic clip applier adapted to deliver asymmetric, polymer ligating clips.
According to one embodiment, an apparatus is provided for applying polymeric latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, and a jaw assembly for receiving a clip from the elongate assembly. The elongate assembly comprises a distal end. The jaw assembly comprises first, second, third and fourth jaw legs spaced apart from each other for substantially simultaneously engaging at least four portions of the clip. Each leg extends from the distal end and is actuatable toward at least one other opposing leg for compressing the clip.
According to another embodiment, an apparatus is provided for applying polymeric latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, a jaw assembly, and an actuator assembly. The elongate assembly comprises an axially movable distal end section. The distal end section comprises a plurality of distal cam surfaces generally spaced around a cross-section of the distal end section. The jaw assembly comprises first and second opposing jaws for compressing a clip therebetween. The jaw assembly extends from the elongate assembly. The actuator assembly communicates with the distal end section for actuating the distal cam surfaces into contact with the jaw assembly to cam the first and second jaws toward each other.
According to yet another embodiment, an apparatus is provided for applying polymeric latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, a jaw assembly, and an actuator assembly. The elongate assembly comprises a distal end, an axially movable clip feeding member, and an axially movable jaw actuating member. The jaw assembly extends from the distal end and comprises first and second opposing jaws for compressing a clip therebetween. The actuator assembly is actuatable through a first stage and a subsequent second stage of a forward stroke. The actuator assembly is coupled with the clip feeding member for moving the clip feeding member into contact with the clip to feed the clip into the jaw assembly during the first stage. The actuator assembly communicates with the jaw actuating member for moving the jaw actuating member into contact with the jaw assembly to close the clip during the second stage. The clip feeding member remains coupled with the actuator assembly for maintaining contact with the clip during the second stage.
According to still another embodiment, an apparatus is provided for applying polymer latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, a jaw assembly, and an actuator assembly. The elongate assembly comprises a distal end and an axially movable clip feeding device. The jaw assembly extends from the distal end and comprises first and second opposing jaws for compressing a clip therebetween. The first and second jaws comprise respective first and second hook structures. The actuator assembly is coupled with the clip feeding device for moving the clip feeding device toward the jaw assembly during a clip feeding stroke and a subsequent clip opening stroke. During the clip feeding stroke, the actuator assembly moves the clip feeding device into contact with the clip for feeding the clip from the elongate assembly into the jaw assembly. During the clip opening stroke, the actuator assembly through the clip feeding device urges the clip against the first and second hook structures for forcing the clip and the first and second jaws into a fully open position.
According to a further embodiment, an apparatus is provided for applying polymeric latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, a jaw assembly, and a clip feeding member. The elongate assembly comprises an elongate assembly distal end. The jaw assembly extends from the elongate assembly distal end for receiving a clip from the elongate assembly. The clip feeding member is axially movable along a length of the elongate assembly for feeding the clip into the jaw assembly. The clip feeding member comprises a feeding member proximal end for coupling with an actuator, and an opposing feeding member distal end. The feeding member distal end comprises a feeder tab. The feeder tab comprises a concave surface for contacting a convex proximal hinge portion of the clip.
According to a yet further embodiment, an apparatus is provided for applying polymeric latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, a jaw assembly for receiving clips from the elongate assembly, an actuator assembly, and a ratchet member. The elongate assembly comprises a clip feeding member and a jaw actuating member. The actuator assembly comprises a ratchet surface. The actuator assembly is coupled to the clip feeding member for moving the clip feeding member in a distal direction during a first stroke portion for feeding a clip into the jaw assembly and forcing said clip to an open position once in the jaw assembly. The actuator assembly communicates with the jaw actuating member for moving the jaw actuating member into engagement with the jaw assembly during a second stroke portion for closing the jaw assembly and allowing the jaw assembly to reopen. The ratchet member is coupled to the actuator assembly. The ratchet member is actuatable into engagement with the ratchet surface during the first stroke portion for preventing movement of the clip feeding member in a proximal direction. The ratchet member is actuatable out of engagement with the ratchet surface during the second stroke portion for enabling movement of the jaw actuating member in both the distal and proximal directions.
According to an additional embodiment, an apparatus is provided for applying polymeric latching clips in an endoscopic surgical procedure. The apparatus comprises an elongate assembly for containing polymeric latching clips, a jaw assembly, a clip feeding member, an actuator assembly, and a clip rotating member. The elongate assembly comprises a distal end. The jaw assembly extends from the distal end for receiving clips from the elongate assembly. The clip feeding member is axially movable along a length of the elongate assembly for feeding a clip into the jaw assembly. The actuator assembly is actuatable through a forward stroke and a return stroke. The actuator assembly is coupled to the clip feeding member for moving the clip feeding member toward the jaw assembly during the forward stroke to feed a clip therein, and for moving the clip feeding member away from the jaw assembly during the return stroke. The clip rotating member is disposed in the distal end and is contactable with the clip for rotating the clip in response to movement of the clip feeding member.
According to a method for applying a polymeric latching clip at a surgical site, a clip disposed in a clip applying apparatus is fed into a jaw assembly thereof. The jaw assembly comprises at least four jaw legs substantially simultaneously engaging at least four respective portions of the clip. The jaw assembly is actuated to compress the clip while the at least four clip portions remain respectively engaged with the at least four jaw legs to stabilize the clip during compression.
According to another method for applying a polymeric latching clip at a surgical site, a clip disposed in a clip applying apparatus is fed into a jaw assembly thereof. The jaw assembly comprises first and second opposing jaws. The first and second jaws are cammed together to compress the clip. The camming is accomplished by moving at least first and second jaw actuating surfaces into contact with the first jaw, and moving at least third and fourth jaw actuating surfaces into contact with the second jaw. The clip is thereby compressed in a stable manner and is subjected to forces distributed among the at least first, second, third and fourth jaw actuating surfaces.
According to yet another method for applying a polymeric latching clip at a surgical site, a clip disposed in a clip applying apparatus is fed into a jaw assembly thereof. The jaw assembly is actuated to compress the clip by moving first and second opposing legs of the clip toward each other. A rear portion of the clip adjoining the first and second clip legs is engaged while actuating the jaw assembly to stabilize the clip during compression thereof.
According to a method for preparing a polymeric latching clip for application at a surgical site, a clip disposed in a clip applying apparatus is fed into first and second opposing jaws of a jaw assembly of the apparatus. The first jaw comprises a first hook structure, and the second jaw comprises a second hook structure. Feeding the clip causes the first and second opposing legs of the clip to engage the first and second hook structures, respectively. The first and second clip legs are urged against the respective first and second hook structures to urge the clip and the jaw assembly into a fully open state for facilitating positioning the clip at a surgical site in preparation for applying the clip.
According to a method for enabling a polymeric latching clip to be approximated in preparation for applying the clip at a surgical site, a clip feeding device of a clip applying apparatus is actuated in a distal direction to feed a clip into a jaw assembly of the apparatus during a first stage of a forward stroke of the apparatus. The clip is prevented from moving in a proximal direction away from the jaw assembly during the first stage. During a second stage of the forward stroke subsequent to the first stage, the jaw assembly is enabled to be selectively actuated between alternate open and closed positions for controllably manipulating the clip during the second stage in preparation for applying the clip.
According to another method for preparing a polymeric latching clip for application at a surgical site, a clip disposed in a clip applying apparatus is rotated to align a rear portion of the clip adjoining two opposing legs thereof with a feeder tab of the apparatus. The clip is fed into a jaw assembly of the apparatus by actuating the feeder tab into contact with the rear clip portion.
It is therefore an object of the subject matter disclosed herein to provide an endoscopic clip applier and method.